The government has been rather clever by focussing on GP commissioning. The contact most people have with the NHS is through their GP and if they have a good experience (88% of people do, compared with 72% satisfied with the NHS overall) then they put their confidence in their GP. The message that the Conservatives used during the 2010 election, and since, is that they would put GPs "in control". The problem is that when the Bill appeared it became clear that GPs would not be "in control", instead Consortia would be in control, and the Bill does not even mandate that they are run by GPs. The plan was a clever one, but it was sunk by the facts.
However, when you ask anyone to identify what they think most embodies the NHS they will not say their GP, instead, most will point to their local hospital. The NHS ensures that there is an acute hospital covering all of the population: the Secretary of State must provide this (the Bill, of course, removes this compulsion). Threaten a hospital and people get upset; very upset.
Today, Ed Miliband shows that he realises this. In today's press conference it is reported:
Mr Miliband said, under the plans, hospital could face huge fines for breaching competition law, could "go bust" as they would be subject to insolvency laws, health service decisions could end up being "made in the courts" and hospitals could convert whole wards to become private wards only.This is important. What he is saying is that the Lansley plan will affect our local NHS hospitals: competition law imposed by a large national organisation (or a supra-national organisation if EU competition law applies) could close cherished local NHS hospitals. Labour have learned, far too late, that decisions made by a distant power (however right they may be) are not popular if they affect local hospitals. Under Labour the "distant power" was the Department of Health (the Conservatives and Liberal Democrats have tried to paint PCTs as such malevolent "distant powers" as a way to justify their demise, but this argument has not worked with the public), now Miliband is identifying another unaccountable "distant power", Monitor. The more that Labour maligns Monitor, the less the public can justify its powers. To the public Monitor will be seen as enforcing competition law that will close their local hospital: all negative aspects. The government will find it difficult to persuade the public that there are any "good" aspects to Monitor.
Miliband also makes an interesting allusion to the policy of removing the private patient income cap (PPI). He says "hospitals could convert whole wards to become private wards only". The PPI cap means that NHS Foundation Trust hospitals are restricted to the proportion of private income they can generate: this does not prevent them from doing private work, but it does mean that if a trust does more private work it has to do proportionally more NHS work. Removing the PPI cap means that hospitals (and particularly those in big cities, principally London) could increase their private work and squeeze NHS patients out.
The phrase "whole wards to become private wards only" is important because it heralds a two-tier system. Miliband has tapped into the inherent decency of the NHS: when it comes to ill health we are all equal; your access to treatment should not be dependent on your wealth. The government has gone to great lengths (sometimes inappropriately) to emphasise that the NHS will still remain "free at the point of use", but they avoid the issue of a two tier system. Miliband explaining that the Lansley Plan will lead to wealth determining a different, perhaps even better, care is political dynamite.
After floundering for months for a narrative it now appears that Ed Miliband has found the right combination to attack the government. Ed Miliband gets it.